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Please complete the order information and form below.
A background check typically takes 3-5 business days to complete, and turnaround time of drug screening results, if included, is determined by a variety of factors. Your report and/or drug screening results will be provided directly to your clinical site or school upon completion.

If you have already ordered your background check, you may go here to check the status.

* Please provide your Country of residence.

USA

Other

*Country Name

*First Name

*Current Address

*Middle Initial or Middle Name

*City/Province

*Last Name

*State/Region

*DOB ex. 12/31/1970

*Zip
Code

Driver License#:

*Phone
ex. ###-###-####

Issued By:(State/Country)

*e-mail

I-94

*Confirm e-mail

*Social Security No.

Social Security No or USCIS Form I-94
(Arrival-Departure Record)

-
-

*Confirm SSN

-
-

And/Or

Foreign National Identification Number(NIN)

Document Type

Other Names

First Name

Middle Name

Last Name

Alias 1:

Alias 2:

Alias 3:

Alias 4:

*Please provide all prior locations where you have resided for the past seven (7) years:

*Address

*City/Province

*State/Region

*Country

Zip

Address

City/Province

State/Region

Country

Zip

Address

City/Province

State/Region

Country

Zip

Address

City/Province

State/Region

Country

Zip

Address

City/Province

State/Region

Country

Zip

Address

City/Province

State/Region

Country

Zip

Address

City/Province

State/Region

Country

Zip

use the More button to add more addresses

My present employer may be contacted for a job reference?

Yes

No

Name of Employer

Supervisor

Phone #

Dates of Employment ex. 01/2005

Address City/Province

State/Region

Country

Zip

From To

Name of Employer

Supervisor

Phone #

Dates of Employment ex. 01/2005

Address City/Province

State/Region

Country

Zip

FromTo

Name of Employer

Supervisor

Phone #

Dates of Employment ex. 01/2005

Address City/Province

State/Region

Country

Zip

FromTo

Name of Employer

Supervisor

Phone #

Dates of Employment ex. 01/2005

Address City/Province

State/Region

Country

Zip

FromTo

Name of Employer

Supervisor

Phone #

Dates of Employment ex. 01/2005

Address City/Province

State/Region

Country

Zip

FromTo

Name of Employer

Supervisor

Phone #

Dates of Employment ex. 01/2005

Address City/Province

State/Region

Country

Zip

FromTo

use the More button to add more employments

Please complete the following regarding your education.

(type "none" where not applicable)

*Name of High School, College, University, or Institution of Professional Training where you completed the highest level

Highest level is GED (applicable to U.S. students only)

*GED State

*Campus Name

*Campus City/Province

*Campus State/Region

Campus Country

*Name under which you graduated or name on GED

*Attended Dates

From
To

OR

*Year Graduated/Completed GED

Please list any current healthcare licenses you hold.

License Type

License State/Region

License Country

License Number

License Type

License State/Region

License Country

License Number

License Type

License State/Region

License Country

License Number

License Type

License State/Region

License Country

License Number

License Type

License State/Region

License Country

License Number

License Type

License State/Region

License Country

License Number

use the More button to add more licenses

* Have you ever been convicted of a crime?

Yes

No

*Where City/Province

*State/Region

*Country

When (mm/yyyy)

Offense

Where City/Province

State/Region

Country

When (mm/yyyy)

Offense

Where City/Province

State/Region

Country

When (mm/yyyy)

Offense

Where City/Province

State/Region

Country

When (mm/yyyy)

Offense

Where City/Province

State/Region

Country

When (mm/yyyy)

Offense

use the More button to add more offenses

* Method of Payment.

Credit Card

Money Order

Debit/Credit Card Type

Name on Card

Card Number

Expiration

Billing Address1

Billing Address2

City

State

Zip

Who Does the CreditCard belong to?

Self

Other

* Relationship to Cardholder .

* Card holder's Contact Number .

Subtotal

Tax

Money Order Handling Fee

This fee is required to offset the cost of handling money orders.

Total

To pay by money order, please send money order made payable to "PreCheck, Inc." with a copy of the email you will receive confirming your order. Mail to PreCheck, Inc., 2500 E T C Jester Blvd. Suite 600 Houston, TX 77008. Your background check will not be started until your money order is received. PERSONAL CHECKS NOT ACCEPTED.